KATIE D CLARK RD, LDN
NPI 1689455594
Dietitian, Registered in Philadelphia, PA

Q: What is Katie Clark's NPI number?

The NPI number for Katie Clark is 1689455594. It was assigned to this individual provider in the NPPES registry on October 9, 2023.

Q: What is Katie Clark's specialty?

The primary specialty registered for this NPI is Dietitian, Registered with taxonomy code 133V00000X.

Q: Is Katie Clark enrolled in Medicare?

No. Katie Clark has opted out of Medicare through May 2, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Q: When was this NPI record last updated?

The NPPES record for Katie Clark was last updated on October 9, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since October 09, 2023Opted out of Medicare · through May 2, 2028

1807 WATERLOO ST, PHILADELPHIA, PA 19122(267) 768-8739 Get Directions Write a Review

NPPES record last updated: October 9, 2023. Verified against the NPPES registry weekly; last sync: August 23, 2026.

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About Katie D Clark Rd, Ldn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KATIE D CLARK RD, LDN (NPI 1689455594) is an individual dietitian, registered in Philadelphia, Pennsylvania and active in the NPI registry since October 2023. She has opted out of Medicare through May 2, 2028.

NPPES Registry Identity

NPI1689455594

Entity TypeIndividualFemale

Primary Taxonomy133V00000X

Provider Legal NameKATIE D CLARKCredential: RD, LDN

Location Address1807 WATERLOO STPhiladelphia, PA 19122-2422

Mailing Address1807 Waterloo StPhiladelphia, PA 19122-2422 · (267) 768-8739

Phone(267) 768-8739

Sole ProprietorYes

Enumeration DateOctober 9, 2023

NPPES CertifiedOctober 8, 2023

✔ NPI 1689455594 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDietitian, RegisteredDietary & Nutritional Service Providers

Taxonomy Code133V00000X

Definition

A Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession's systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation.

1807 WATERLOO ST, Philadelphia, PA 19122

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

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Opted out of Medicare

Katie D Clark Rd, Ldn has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from May 2, 2024 through May 2, 2028.

Opt-Out Effective DateMay 2, 2024

Opt-Out In Effect ThroughMay 2, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MIND BELLY SOUL NUTRITION LLC

Clinic/Center (Health Service)

1807 WATERLOO ST
PHILADELPHIA, PA 19122

Philadelphia County (678) 656-5830

DR. JESSE ALLEN SMITH LMFT

Marriage & Family Therapist

1807 WATERLOO ST
PHILADELPHIA, PA 19122

Philadelphia County (256) 393-4039

DR JESSE SMITH THERAPY LLC

Marriage & Family Therapist

1807 WATERLOO ST
PHILADELPHIA, PA 19122

Philadelphia County (484) 278-3319

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Katie Clark's NPI number?

The NPI number for Katie Clark is 1689455594. It was assigned to this individual provider in the NPPES registry on October 9, 2023.

Where is Katie Clark located?

Katie Clark practices at 1807 Waterloo St, Philadelphia, PA 19122. The listed phone number is (267) 768-8739.

What is Katie Clark's specialty?

The primary specialty registered for this NPI is Dietitian, Registered with taxonomy code 133V00000X.

Is Katie Clark enrolled in Medicare?

No. Katie Clark has opted out of Medicare through May 2, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Katie Clark was last updated on October 9, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.